钢缆内固定锁骨近段和胸骨髓腔修复胸锁关节脱位：解剖与临床  

Fixation of proximal clavicle and sternum through the intramedullary cavity for sternoclavicular joint dislocation with wire rope: an anatomic and clinical research

作　　者：董加纯[1] 支中正[1] 颜冰珊[1] 丁磊[1] 尹望平[1] 戴增寿 

机构地区：[1]复旦大学附属金山医院骨科,复旦大学上海医学院外科学系,上海市201508 [2]复旦大学上海医学院解剖组胚系,上海市200032

出　　处：《中国组织工程研究》2014年第4期583-588,共6页Chinese Journal of Tissue Engineering Research

基　　金：上海市金山区卫生局项目(2010-1)~~

摘　　要：背景:对于需要内固定治疗的胸锁关节脱位,因其毗邻纵膈等重要结构,风险相对较大,而内固定方法多样,仍存争议。目的:探讨通过锁骨近段髓腔和胸骨髓腔内固定治疗胸锁关节脱位的可行性与有效性。方法:在防腐固定的22侧成人上肢标本上,观测胸锁关节形态、相关韧带等解剖学特点,测量锁骨内侧端、胸骨柄之关节面大小,关节盘形态,肋锁韧带、胸锁韧带形态。2009年1月至2012年7月用钢缆或可吸收缝线"8"形内固定治疗胸锁关节脱位患者3例,均为男性,年龄9,45,62岁,平均年龄38.6岁,采用上肢功能DASH评分对内固定效果进行评估。结果与结论:解剖学结果显示,锁骨内侧端关节面的前后径、冠状径都要大于胸骨柄上关节面的前后径、冠状径,2者之间并不匹配;胸骨柄在关节面上缘处的厚度最小,胸骨角处的厚度最大;胸骨柄的宽度在关节面上缘水平最小,关节面下缘最宽。关节盘的外观近,似椭圆形,冠状径大于前后径,与胸骨柄侧关节面较匹配,中央厚度大于边缘厚度。肋锁韧带厚度要明显大于胸锁前韧带和胸锁后韧带,外观更为致密;胸锁前韧带和胸锁后韧带的长、宽、厚较接近。临床试验结果显示,3例患者随访时间14-36个月,DASH评分10-16分,平均13.3分,内固定效果满意。提示通过钢缆或可吸收缝线近段锁骨髓腔和胸骨髓腔内固定修复胸锁关节脱位安全有效。BACKGROUND： Surgical management of sternoclavicular joint dislocation takes relatively larger risks for its adjacent mediastinal and other important structures. However, the surgical methods are varied and remain controversial. OBJECTIVE： To investigate the feasibility and validity of intramedullary fixation of the proximal clavicle and sternum for sternoclavicular joint dislocation. METHODS： On 22 adult cadaver upper limb specimens, the anatomical features of the sternoclavicular joints and associated ligaments, the size of articular surface between the medial clavicle and manubrium and the morphology of articular disc, costoclavicular ligament and sternoclavicular ligament were observed and measured. From January 2009 to July 2012, three patients with sternoclavicular joint dislocation received the intramedullary fixation with wire rope or absorbable suture in figure-of-eight shape. They were males, aged 9, 45 and 62 years, with an average age of 38.6 years. The outcome was evaluated by upper limb function DASH score. RESULTS AND CONCLUSION： Anatomic results demonstrated that the anteroposterior and coronal diameters of the surface of the medial clavicle were greater than that of the sternum, so they did not match each other. The minimum thickness of the manubrium sterni was at the superior margin of articular surface and the largest was at the sternal angle. The minimum width of the manubrium sterni was at the superior margin of articular surface and the largest was at the inferior margin. The articular disc, liked an ellipse and matched with the articulating surface of the manubrium sterni more, whose anteroposterior diameter was greater than its coronal diameter. Central thickness was greater than the edge thickness. The costoclavicular ligament was thicker and denser than the anterior and posterior sternoclavicular ligament. The anterior and posterior sternoclavicular ligaments were close in length, width and thickness. Clinical trial results demonstrated that all cases were followed up for 14 to

关 键 词：植入物 骨植入物 胸锁关节 应用解剖 脱位 钢缆 "8"形固定 DASH评分 

分 类 号：R318[医药卫生—生物医学工程]